Provider Demographics
NPI:1639262132
Name:PENDLETON, TERRIE LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:TERRIE
Middle Name:LYNN
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5002 MONUMENT AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3634
Mailing Address - Country:US
Mailing Address - Phone:804-497-4676
Mailing Address - Fax:804-497-4677
Practice Address - Street 1:5002 MONUMENT AVE
Practice Address - Street 2:STE 201
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3634
Practice Address - Country:US
Practice Address - Phone:804-497-4676
Practice Address - Fax:804-497-4677
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA090040049271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical